Hypertension – Introduction

Last week I discussed Plantar Fasciitis one of the major causes of heel pain, this week I am going to discuss a grumbling achilles tendon, or to be technically correct, non-insertional Achilles tendinopathy, he other major cause of heel pain.  Although a rupture of the Achilles is well known, it is actually more common to have what is known as a grumbling Achilles. The pain is felt at the back of the heel above where the Achilles tendon joins the bone. It feels stiff and swollen, particularly in the morning and can prevent the sufferer from taking part in sport. Sometimes the pain is lower down where the tendon joins the bone. How can I tell if my heel pain is a grumbling achilles tendon? You may have swelling over or either side of your achilles tendon which runs from your heel to your calf muscles.  The skin over the achilles tendon may be red and/or hot.  If you sit down with your feet on the floor and raise your foot, as you use your achilles tendon you may hear a crackling sensation. What causes a grumbling achilles tendon?

• The tab on your shoe rubbing against your achilles tendon.
• Failing to warm up properly before playing sports.
• Over use of the tendon from intensive training, e.g. running
• Scar tissue from a previous injury.
• High impact on hard surfaces e.g. any sport where you jump or tennis.

What can I do to help myself? If you are in pain then rest and ice your tendon, to ice it wrap ice cubes in a tea-towel and hold against your tendon for 5 - 20 minutes, every 2 hours for 2 -3  days and then 3 times a day. The key to preventing further bouts is to ensure your are wearing appropriate footwear for the sport you are doing, ensure you warm up and cool down properly and always stretch your calf muscles. In addition a deep tissue massage release any tension in the tendon, remove scar tissue and ensure that your calf muscles are flexible.  

Recently a client asked me "is having heel pain first thing in the morning, just one of those things you have to put up with as you get older"?. What are the causes of Heel Pain? There are two major causes of heel pain, firstly a grumbling Achilles Tendon and secondly Plantar Fasciitis.  This week I am going to focus on Plantar Fasciitis.  Plantar Fasciitis is inflammation of the Plantar Fascia or the strong band of tissue on the sole of your foot that stretches from your heel to your toes that supports the arch of your foot and acts as a shock absorber when you walk.  The usual site of the pain with Plantar Fasciitis  is on the sole of the foot, see diagram below. How can I tell if my heel pain is Plantar Fasciitis? Plantar Fasciitis is characterised by the gradual onset of soreness and aching under the heel at its mid-point, which spreads forward along the inner side of the arch of the foot.   The ache or pain is often for the first few steps when you get out of bed every morning or after sitting at your desk for a long period of time. What causes Plantar Fasciitis

• Sedentary Lifestyles
• Being overweight
• Wearing shoes with too little arch support or cushioning
• Vigorous take off's, landings are fast turns during weight bearing sports.
• Wearing high heels too much.
• Excessive foot eversion (your weight is too much on the outside of your foot).

What can I do to help myself? If you are in pain, then simply rest and ice.  A simple solution is to freeze a plastic water bottle which is about 75% full of water - when it is frozen wrap it in a tea towel, so you don't burn your skin and roll it under the sole of your feet to provide pain relief. The following exercises, done either with or without shoes on, can be used to help treat Plantar Fasciitis:

• Stand about 40 cm away from a wall and put both hands on the wall at shoulder height, feet slightly apart, with one foot in front of the other. Bend your front knee but keep your back knee straight and lean in towards the wall to stretch. You should feel your calf muscle tighten. Keep this position for several seconds, then relax. Do this about 10 times then switch to the other leg. Now repeat the same exercise for both legs but this time, bring your back foot forward slightly so that your back knee is also slightly bent. Lean against the wall as before, keep the position, relax and then repeat 10 times before switching to the other leg. Repeat this routine twice a day.
• Stand on the bottom step of some stairs with your legs slightly apart and with your heels just off the end of the step. Hold the stair rails for support. Lower your heels, keeping your knees straight. Again you should feel the stretch in your calves. Keep the position for 20-60 seconds, then relax. Repeat six times. Try to do this exercise twice a day.
• Sit on the floor with your legs out in front of you. Loop a towel around the ball of one of your feet. With your knee straight, pull your toes towards your nose. Hold the position for 30 seconds and repeat three times. Repeat the same exercise for the other foot. Try to do this once a day.
• Sit on a chair with your knees bent at right angles and your feet and heels flat on the floor. Lift your foot upwards, keeping your heel on the floor. Hold the position for a few seconds and then relax. Repeat about 10 times. Try to do this exercise five to six times a day.
• For this exercise you need an object such as a rolling pin or a drinks can. Whilst sitting in a chair, put the object under the arch of your foot. Roll the arch of your foot over the object in different directions. Perform this exercise for a few minutes for each foot at least twice a day. This exercise is best done without shoes on.

Finally, a deep tissue massage to the calf muscles, achilles tendon and foot will help too.

Often clients sit down to have a massage and are unaware how tight one area of there shoulder or neck is.  This is very common and here is why:

• We only notice the worse area of pain - so if our right shoulder is more painful, we have a tendency to assume our left shoulder is OK.
• Trigger Points

What are Trigger Points? Trigger Points are hyper-irritable spots in muscle which are between 2mm - 10mm in diameter that are located frequently located where the nerves join the muscle fibers.  Active trigger points are always tender or painful, and often refer pain, so trigger points in only of the largest shoulder muscles the trapezius often refers pain up the side of the neck.  While latent trigger points are only painful when they are touched.  This is why when I work, sometime you discover areas of your shoulders that you didn't know were painful, these are latent trigger points. Trigger points can be found anywhere in the body but are extremely common in the shoulders. So if latent trigger points are only painful when you touch them, do I need a massage to release them?  The simple answer is yes as they may restrict your range of movement, so you will feel tightness if you try and rotate your shoulders or they can reduce the strength of your muscles, which puts more strain on your joints. What causes trigger points? There are several ideas about what causes trigger points but no agreed theory.  Below is a list of possible causes

• Poor Posture
• Muscle Damage
• Nervous Tension
• Physical Stress
• Psyschological Stress
• Environmental Factors - cold, damp
• Illness
• Lack of rest or sleep
• Poor Diet

What are the symptoms of trigger points?

• Restricted movement
• Tension headaches
• Referred pain
• Painful movement of a joint or limb

How can I prevent trigger points forming?

• Maintain good posture
• Manage your stress
• Follow a daily stretching routine

How can I get rid of my trigger points?

• Acupuncture
• Massage